All kinds of heart arrhythmias, and in particular chronic and paroxysmal atrial fibrillation, can currently be treated by surgery.
A known surgical procedure (MAZE) was designed to eliminate atrial fibrillation permanently. In this procedure incisions are made with a scalpel in the walls of the atria, in order to block electrical impulse conduction in a direction crosswise to the incisions, by the interruption of the tissue continuity. As a result of the subsequent scarring, these electrical blocks acquire a permanent character.
This known technique is as yet performed only to a limited extent worldwide, owing to the complexity of the operation. The increased risk is particularly associated with the duration of the operation and the way in which the operation has to be carried out.
The duration of the operation, and in particular the cross-clamp time (x-clamp) is so long that there is a great risk of damage to the heart muscle.
The cross-clamp time required for the MAZE procedure alone is currently still an average of 68 min. (range 50–102 min.), and the necessary time on the heart-lung machine is on average 182 min. (range 130–256 min.). For further data you are referred to Atrial Fibrillations: Mechanisms and Therapeutic Strategies, Futura Publishing Co. Inc. Armonk, N.Y. 1994. J. L. Cox: Surgical Interruption of Atrial Reentry as a Cure for Atrial Fibrillation. The way in which the operation is performed with the scalpel produces an increased risk of vascular suture leaks and subsequent bleeding, due to the large number and location of the vascular sutures involved.